<!DOCTYPE html>
<html lang="en">
<head>
    <script src="https://cdn.bootcss.com/jquery/3.3.1/jquery.min.js"></script>
    <link rel="stylesheet" href="/Public/Common/plugin/layui-v2.2.6/layui/css/layui.mobile.css">
    <link rel="stylesheet" href="/Public/Common/plugin/layui-v2.2.6/layui/css/layui.css">
    <script src="/Public/Common/plugin/layui-v2.2.6/layui/layui.js"></script>
</head>
<body>
<form action="{:U('verification')}" class="layui-form" method="post">
    <table class="layui-table">
        <tr>
            <td>
                验证码
            </td>
            <td>
                <input type="hidden" name="VerifyCode" value="d41d8cd98f00b204e9800998ecf8427e" class="layui-input">
                <input type="text" value="d41d8cd98f00b204e9800998ecf8427e" class="layui-input" disabled>
            </td>
        </tr>
        <tr>
            <td>
                远端订单号
            </td>
            <td>
                <input type="text" name="OrderCall" value="" class="layui-input">
            </td>
        </tr>
        <tr>
            <td>
                票付通订单号
            </td>
            <td>
                <input type="text" name="Order16U" value="" class="layui-input">
            </td>
        </tr>
        <tr>
            <td>
                通知类型
            </td>
            <td>
                <select name="OrderState">
                    <option value="1">全部消费通知</option>
                    <option value="6">取票通知</option>
                    <option value="7">部分消费通知</option>
                    <option value="8">退款审核结果通知</option>
                    <option value="9">特殊退款通知</option>
                </select>
            </td>
        </tr>
        <tr>
            <td>
                渠道
            </td>
            <td>
                <select name="Source">
                    <option value="2">内部</option>
                    <option value="4">终端</option>
                </select>
            </td>
        </tr>
        <tr>
            <td>
                操作类型
            </td>
            <td>
                <select name="Action">
                    <option value="1">有效期内消费</option>
                    <option value="2">过期消费</option>
                    <option value="3">修改/取消（验证前）</option>
                    <option value="4">撤改/撤销（验证后）</option>
                    <option value="5">供应商过期取消</option>
                    <option value="6">取票</option>
                </select>
            </td>
        </tr>
        <tr>
            <td>
                执行时间
            </td>
            <td>
                <input type="date" name="ActionTime" value="{:date('Y-m-d',time())}" class="layui-input">
            </td>
        </tr>
    </table>

    <table class="layui-table">
        <tr>
            <td>本次消费票数</td>
            <td>
                <input type="text" name="Tnumber" value="" class="layui-input">
            </td>
        </tr>
        <tr>
            <td>总消费数</td>
            <td>
                <input type="text" name="AllCheckNum" value="" class="layui-input">
            </td>
        </tr>
    </table>

    <input type="submit" class="layui-btn">
</form>

<script>
    layui.use(['form'], function(){
        var form = layui.form;
    });
</script>
</body>
</html>